MEDICARE: TIA M GAFFNEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1598004541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIA M GAFFNEY

Provider Business Mailing Address
First Line	:	2109 BRANCH HILL ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-5119
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2109 BRANCH HILL ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-5119
Country	:	US
Telephone Number	:	813-490-5490
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2013
Last Update Date	:	02/12/2013

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Directions to “ TIA M GAFFNEY ” Practice Location

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